Bone Marrow Adiposity, Bone Mineral Density and Wnt/β-catenin Pathway Inhibitors Levels in Hemodialysis Patients

Abstract

Background: Marrow adipose tissue (MAT) is known to accumulate in patients with chronic kidney disease. This pilot study aimed to evaluate bone mineral density (BMD), MAT, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) using computed tomography (CT) scans and to explore correlations between bone parameters, circulating Wnt/β-catenin pathway inhibitor levels, and adipose tissue parameters.Methods: Single-center cross-sectional pilot study conducted in hemodialysis patients at the Centre Universitaire de Québec, Hôtel-Dieu de Québec hospital, Canada. CT-scan slices were acquired at the levels of the hip, L3 vertebra, and tibia. Volumetric and areal BMD, tibia cortical thickness, VAT and SAT area, and fat marrow index (FMI) were analyzed using the Mindways QCT Pro software. Blood levels of sclerostin, dickkopf-related protein 1 (DKK1), fibroblast growth factor 23, and α-Klotho were assessed. Spearman’s rho test was used to evaluate correlations.Results: Fifteen hemodialysis patients (median age, 75 [66–82] years; 80% male; dialysis vintage, 39.3 [27.4–71.0] months) were included. While inverse correlations were obtained between L3 FMI and BMD, positive correlations were found between proximal tibial FMI and vertebral and tibial BMD, as well as with tibial (proximal and distal) cortical thickness. VAT had a positive correlation with α-Klotho levels, whereas L3 FMI had a negative correlation with DKK1 levels.Conclusions: CT-scan allows simultaneous evaluation of bone and marrow adiposity in dialysis patients. Correlations between MAT and BMD vary depending on the bone site evaluated. DKK1 and α-Klotho levels correlate with adipose tissue accumulation in dialysis patients.

Relationships between Circulating Sclerostin, Bone Marrow Adiposity, Other Adipose Deposits and Lean Mass in Post-Menopausal Women

“…No evidence of an association between circulating sclerostin levels and BMA was found, either at the lumbar spine or proximal femur, which is consistent with the findings in post-menopausal women in the study conducted by Ma et al [ 7 ]. Furthermore, in a single-center cross-sectional pilot study conducted in 15 hemodialysis patients, Wang et al did not find a correlation between circulating sclerostin and BMA at L3 [ 29 ].…”

Relationship between bone marrow adipose tissue and kidney function in postmenopausal women

“…To date, only two studies have explored BMAT measurements in patients with advanced CKD treated with hemodialysis or renal transplantation ( Hernandez et al, 2018b ; Wang et al, 2022b ). As these studies are beyond the scope of this article, they are not reported in detail.…”

“…The results showed that marrow adipocyte area/tissue area and marrow adipocyte volume/marrow volume were higher in patients with advanced CKD than in controls ( Hernandez et al, 2018b ). In another pilot study ( Wang et al, 2022b ), BMD, marrow adiposity index (MAI), VAT, and subcutaneous adipose tissue (SAT) were assessed in 15 hemodialysis patients (median age: 75 [66–82] years; 80 % male) using computed tomography (CT) scans. The main limitation of that study was the lack of a control group (non-CKD participants).…”

“…Further understanding of the mechanisms underlying this association could lead to better diagnosis and treatment of osteoporosis. This might be of particular significance in populations of individuals with metabolic diseases (e.g., diabetes) and chronic kidney disease (CKD), in which BMAT abnormalities have been demonstrated ( Moorthi et al, 2015 ; Wang et al, 2022a ; Hernandez et al, 2018a ; Woods et al, 2018 ). In a small sample size study conducted in 2015, Moorthi et al found that patients with CKD ( n = 8, mean estimated glomerular filtration rate (eGFR) = 24 ml/min/1.73 cm 2 ) had higher lumbar spine PDFFs than healthy adults matched for race, sex, and age ( Moorthi et al, 2015 ).…”